Stepping into the Unknown: Unveiling the Rarity of PCL Fracture-Avulsions.

Tears of the posterior cruciate ligament (PCL) are rare, and avulsion fracture of the tibial attachment of the posterior cruciate ligament is even rarer. These injuries usually occur in accidents such as car crashes, causing acute pain, swelling as well as total functional impotence of the knee. Studies on the incidence of these injuries show variable results, but there appears to be an upward trend. The surgical management of PCL avulsion fracture is not clearly established, although arthroscopic techniques are becoming more popular due to their potential benefits. However, some medical centers may have limited access to these methods, thus preferring open surgery options. A case of LCP avulsion fracture in a 36-year-old female patient was reported, and surgery was successfully performed, leading to full recovery after six months with full knee mobility and posterior stability.

Surgical treatment of Hahn-Steinthal fracture using Herbert screws.

Hahn-Steinthal fractures are rare and often neglected. Their initial management should be early, given the relatively high complication rate. We report eight cases of type I capitellum fractures treated by Herbert screw fixation. Between 2019 and 2022, we selected eight patients (six men and two women) with a mean age of 25 years (18-40 years). The mean follow-up was 2 years (1-3 years). Clinical results were assessed using the Mayo Clinic Elbow Performance Score (MEPS). The mean arc of mobilitý was 135° (105°-150°) for flexion/extension and 161° (150°-175°) for pronosupination. The mean MEPS was 90.6 points, with seven excellent results and one good result. The aim of this study was to highlight the good results of Herbert screw fixation technique in the management of Hahn-Steinthal fractures.

Severe pure open dislocation of the ankle and flexor digitorum longus tendon tear a case report.

Proximal avulsion rupture of the flexor digitorum longus (FDL) tendon associated with an ankle dislocation is extremely rare. We report a case of a 29 years old patient presenting a severe open ankle dislocation with flexor digitorum longus tendon tear after a motorcycle accident. We performed wound debridement, ankle reduction, tendon repair and stabilization with external fixation. At our last follow-up 17 months after the operation, the patient had good functional outcome and returned to work. This report is noticeable as it is, to the best of our knowledge, the third study reporting a case with simultaneous open ankle dislocation and proximal avulsion rupture of the FDL tendon.

Osseous hydatid disease: A mimic of other skeletal pathologies.

Hydatid disease is still endemic in several regions worldwide including Morocco, and is caused in most cases by the larval form of 2 species of the tapeworm Echinococcus: E. granulosus and E. multilocularis. Primary hydatid disease of the bone without systemic involvement is rare. The disease has a silent clinical evolution until it reaches complicated stages. Complications may include pathological fracture, neural deficit, infection, and fistulization of the abscess. Preoperative diagnosis is based on clinical history, imaging findings, and serological tests, which lack high sensitivity and specificity. Although the interpretation of imaging studies can prove to be very confusing because the bone changes evolve with time, and the nonspecificity of these findings often leads to a mistaken diagnosis. The diagnosis requires a high index of suspicion, especially in patients who reside in or travel to sheep-raising areas where hydatid disease is endemic. A high index of suspicion is necessary for the diagnosis, especially in patients that live in or travel to sheep-raising areas where hydatid disease is endemic. The treatment of choice remains surgical, following the principles of a locally malignant lesion. Chemotherapy (albendazole alone or in combination with praziquantel) is indicated when surgery is not possible or as an adjuvant treatment. The prognosis is often poor. We report the case of a 28-year-old woman with long-standing pain in the left hip joint in which the imaging findings were thought of as being either tuberculous or neoplastic. The result of a CT-guided biopsy concurred with an unexpected diagnosis of a hydatid cyst. This case highlights that in the absence of a high index of suspicion for echinococcal infection, the semblance of imaging findings of hydatid disease in the bone to those of other skeletal pathologies can lead to misinterpretation.

Anterior cruciate ligament cysts: About a rare condition.

The purpose of this study was to provide information on cysts of the anterior cruciate ligament (ACL) of the knee. This included an anatomical and radio-anatomical reminder of the cruciate ligaments of the knee, along with details of the epidemiology, etiopathogenesis, anatomical risk factors, clinical presentation, differential diagnosis, and treatment of ACL cysts. A retrospective analysis was conducted, involving the review of 7 radioclinical records from the medical imaging department of Ibn Sina University Hospital in Rabat, covering a period of 3 years (2018-2020), during which 7 cases of ACL cysts were diagnosed. The results revealed that ACL cysts are a rare condition, frequently detected incidentally during the assessment of meniscal lesions. Symptoms commonly include knee pain and limited mobility, and MRI is considered the diagnostic modality of for distinguishing between simple fluid-filled cysts and infiltrative cysts, as well as for ruling out other differential diagnoses. Treatment options include radio-guided infiltration puncture and arthroscopic resection.

Minimally Invasive Technique in the Management of Tibial Pilon Fractures: New Approach and Promising Results.

Background: Comminuted tibial pilon fractures are induced by high-energy mechanisms and are often associated with soft tissue injuries. Their surgical approach is problematic due to postoperative complications. Minimally invasive management of these fractures has a considerable advantage in preserving the soft tissue and the fracture hematoma. Materials and Methods: We conducted a retrospective study of a series of 28 cases treated at the Orthopedic and Traumatological Surgery Department of the CHU Ibn Sina in Rabat over a period of 3 years and 9 months, from January 2018 to September 2022. Results: After a mean follow-up of 16 months, 26 cases had good clinical results according to the Biga SOFCOT criteria and 24 cases had good radiological results according to the Ovadia and Beals criteria. No cases of osteoarthritis were observed. No skin complications were reported. Conclusion: This study highlights a new approach that deserves to be considered for this type of fracture as long as no consensus has been given.

Corrigendum: Schwannome bénin du nerf grand sciatique, à propos de 2 cas.

[This corrects the article DOI: 10.11604/pamj.2014.18.252.4684.].

Corrigendum: Abcès tuberculeux de la face postérieure de la cuisse: à propos d'un cas.

[This corrects the article DOI: 10.11604/pamj.2014.19.50.4683.].

[The role of the retrograde nailing in distal femur fractures: about 7 cases]. / Intérêt du clou rétrograde dans les fractures du fémur distal: à propos de 07 cas.

We report a series of seven cases of fractures of the distal end of the femur treated by retrograde centro-medullary nailing in the Orthopedic-Trauma Department at the Hospital Ibn Sina over the period 30/05/2010 - 30/04/2015. The average age of patients was 54 years, with a slight male predominance (57,1%). Road traffic accidents were the main cause of these fractures (71.4%) and they mostly affected the right side of body (57,1%). From a surgical point of view, the mean time between symptom onset and treatment initiation was 2 days. Spinal anesthesia was performed in five cases. The average length of stay in hospital was 5 days. The mean time of consolidation was 4 months in all patients, there was only one case of delayed consolidation (6 months). Patients had good functional outcomes with mean knee flexion 120°, with only one case of limited flexion 90°. There was one case of consolidation delay and one case of pseudarthrosis. No deaths, or superficial or deep sepsis, or thromboembolic complications or fat embolism were registered. In general we had satisfactory outcomes. Our study highlights that retrograde femoral nailing is an essential osteosynthesis technique for the surgical treatment of the distal femur fractures.

[Elbow abscess revealing cat-scratch disease: about a case]. / Abcès du coude révélant la maladie des griffes du chat: à propos d'un cas.

Cat-scratch disease (CSD) is a common cause of chronic benign lymphadenopathy in the child and the young adult. Bartonella henselae is the agent responsible for this disease. Common symptoms include regional lymphadenopathy associated with fever. We report a clinically atypical and potentially misleading case of a 18-year old girl with CSD revealed by elbow abscess.

[Surgical management of sacroiliac joint lesions in unstable pelvic ring fractures using percutaneous iliosacral screw fixation]. / Traitement chirurgical des lésions sacro-iliaques dans les fractures instables de l'anneau pelvien par vissage sacro-iliaque percutané.

Pelvic fractures, usually are multiple, unstable fractures occuring most frequently due to violent traumatic events. Orthopedic treatment of these lesions is often distressing both to patients and medical personnel since it requires bed discharge or sometimes tractions which can have a duration up to 45 days and can compromise the static and the walking mechanisms; open operative management is difficult, carrying a significant burden in terms of morbidity and associated with vascular (venous plexus), nervous (sacred roots) or septic risk to take into account. For this reason it is generally reserved for patients with neurologic and strongly displaced forms. Percutaneous fixation under fluoroscopy in unstable type B and type C pelvic fractures allows the synthesis of posterior lesions causing instability by fixing the hip bone to S1 or S2 body, a rapid recovery and rehabilitation of walking.

[The role of short Telegraph nail in the treatment of fractures of the upper end of the humerus: about 19 cases]. / La place du clou Telegraph court dans le traitement des fractures de l'extrémité supérieure de l'humérus: à propos de 19 cas.

The fracture of the upper end of the humerus is the third most frequent fracture in the elderly and its distribution is bimodal, preferentially affecting osteoporotic elderly patients after low energy trauma or, more rarely, young subjects as a consequence of severe kinetic mechanism The treatment of complex fractures of the proximal humerus is the subject of much controversy. Telegraph nail is a highly effective therapeutic approach for displaced fractures of the upper end of the humerus. Surgical procedure is easy but with a learning curve; it allows to start rehabilitation protocol immediately after surgery. It is an antegrade nailing material, 15 cm long, with full proximal and distal locking. Proximal locking is secured by 4 cancellous screws, long thread, stable in the nail ensuring perfect solidity of the assembly while the distal locking screw is secured to deltoid tuberosity in the avascular zone and where there is no neural pathway. This study reports 19 case of patients with fractures of the humerus treated with short Telegraph nail between 2013 and 2015. It aims to investigate radio-clinical results and to assess the impact of this technique on shoulder function. Telegraph nail that has been used for more than 12 years or so met and continues to meet with strong success. It allows to trat very effectively simple fractures type 2 and 3, but also 4-fragment valgus impacted fractures Osteosynthesis by Telegraph nail is an efficient, rapid and reproducible surgical treatment option of the fractures of the upper end of the humerus even in case of complex fractures and allows for a more rapid return of shoulder mobility.

[Trochanteric tuberculosis, an often difficult diagnosis]. / La trochantérite tuberculeuse, un diagnostic souvent difficile.

Trochanteric tuberculosis is a rare disease (<2% of osteoarticular tuberculosis), even in high-endemic countries. It is characterized by insidious symptoms. For this reason, diagnosis is often delayed. The authors report a series of 9 cases, the diagnosis was made by bacteriological and histological examinations after imaging assessment (ultrasound, MRI, CT scan). The treatment of this disease is medical (anti-tuberculous antibiotic). Surgical treatment is usually reserved for complications and improves disease progression.

Traumatic obturator dislocation of the hip joint: a case report and review of the literature.

We describe a case of traumatic obturator hip dislocation in an adult. Closed reduction was done under general anesthesia. Post-reduction radiographs showed concentric and congruent reduction of the right hip. Traction was applied for three weeks followed by progressive mobilization and loading. Follow up for two years after the injury showed that the patient achieved a full recovery without any evidence of hip pain or a decreased range of motion. There were no signs of osteonecrosis of the femoral head.